Web-based occupational stress prevention in German micro- and small-sized enterprises - process evaluation results of an implementation study

Miriam Engels, Louisa Scheepers*, Judith Engels, Leif Boß, Rebekka Kuhlmann, Johanna Kuske, Lutz Lesener, Valeria Pavlista, Kira Schmidt-Stiedenroth, Mathias Diebig, Sascha A Ruhle, Florian B Zapkau, Peter Angerer, Jörg Hoewner, Dirk Lehr, Christian Schwens, Stefan Süß, Ines C Wulf, Nico Dragano

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: Structural and behavioral interventions to manage work-related stress are effective in employees. Nonetheless, they have been implemented insufficiently, particularly in micro- and small-sized enterprises (MSE). Main barriers include a lack of knowledge and limited resources, which could potentially be overcome with simplified web-based alternatives for occupational stress prevention. However, there is a lack of implementation research about web-based prevention in realistic settings of MSE.
OBJECTIVE: The aim of this study is to evaluate the implementation process and success of an integrated web-based platform for occupational stress prevention ("System P") and to identify potential barriers for its uptake and use in MSE in Germany.
METHODS: This study with a mixed-methods approach investigates eight process-related outcomes in a quantitative part I (adoption, reach, penetration, fidelity/dose, costs, acceptability) and a qualitative part II (acceptability, appropriateness and feasibility). Part I has a pre-post design with two measurements (6 months apart) with 98 individual participants and part II consists of 12 semi-structured interviews with managers and intercorporate stakeholders.
RESULTS: Part I revealed shortcomings in the implementation process. Adoption/Reach: Despite extensive marketing efforts, less than 1% of the contacted MSE responded to the offer of System P. A total of 40 MSE registered, 24 of which, characterized by good psychosocial safety climate, adopted System P. Penetration: Within these 24 MSE, 15% of the employees used the system. Fidelity/Dose: 11 MSE started a psychosocial risk-assessment (PRA), and no MSE finished it. The stress-management training (SMT) was started by 25 users and completed by 8.
COSTS: The use of System P was free of charge, but the time required to engage with was an indirect cost. Part II added insights on the perception of the web-based intervention: Acceptance of System P by users and stakeholders was good and it was assessed as appropriate for MSE. Results for feasibility were mixed.
CONCLUSIONS: Although System P was generally perceived as useful and appropriate, only a small number of contacted MSE implemented it as intended. Prior experience and sensitivity for occupational (stress) prevention were mentioned as key facilitators, while (perceived) indirect costs were a key barrier. Enabling MSE to independently manage stress prevention online did not result in successful implementation. Increasing external support could be a solution.

Original languageEnglish
Article number1618
Number of pages22
JournalBMC Public Health
Issue number1
Publication statusPublished - 17 Jun 2024


  • Humans
  • Germany
  • Occupational Stress/prevention & control
  • Mental Health
  • Health Promotion
  • Adult
  • Middle Aged
  • Small Business
  • Process Evaluation
  • Program Evaluation
  • Internet-Based Intervention
  • Quantitative Research
  • Qualitative Research
  • Mixed Methods Research
  • Implementation Research
  • MSE


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